Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG

María Inés Pinto-Sanchez; Andrea Nardelli; Rajka Borojevic; Giada De Palma; Natalia Causada Calo; Justin McCarville; Alberto Caminero; Daniel Basra; Alexa Mordhorst; Ekatherina Ignatova; Suzanne Hansen; Melanie Uhde; Gary L. Norman; Joseph A. Murray; Edgardo Smecuol; David Armstrong; Julio C. Bai; Detlef Schuppan; Stephen M. Collins; Armin Alaedini; Paul Moayyedi; Elena F. Verdu; Premysl Bercik

doi:10.1016/j.cgh.2020.08.040

Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG

María Inés Pinto-Sanchez, Andrea Nardelli, Rajka Borojevic, Giada De Palma, Natalia Causada Calo, Justin McCarville, Alberto Caminero, Daniel Basra, Alexa Mordhorst, Ekatherina Ignatova, Suzanne Hansen, Melanie Uhde, Gary L. Norman, Joseph A. Murray, Edgardo Smecuol, David Armstrong, Julio C. Bai, Detlef Schuppan, Stephen M. Collins, Armin AlaediniPaul Moayyedi, Elena F. Verdu, Premysl Bercik

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background & Aims: Many patients with irritable bowel syndrome (IBS) perceive that their symptoms are triggered by wheat-containing foods. We assessed symptoms and gastrointestinal transit before and after a gluten-free diet (GFD) in unselected patients with IBS and investigated biomarkers associated with symptoms. Methods: We performed a prospective study of 50 patients with IBS (ROME III, all subtypes), with and without serologic reactivity to gluten (antigliadin IgG and IgA), and 25 healthy subjects (controls) at a university hospital in Hamilton, Ontario, Canada, between 2012 and 2016. Gastrointestinal transit, gut symptoms, anxiety, depression, somatization, dietary habits, and microbiota composition were studied before and after 4 weeks of a GFD. HLA-DQ2/DQ8 status was determined. GFD compliance was assessed by a dietitian and by measuring gluten peptides in stool. Results: There was no difference in symptoms among patients at baseline, but after the GFD, patients with antigliadin IgG and IgA reported less diarrhea than patients without these antibodies (P = .03). Compared with baseline, IBS symptoms improved in 18 of 24 patients (75%) with antigliadin IgG and IgA and in 8 of 21 patients (38%) without the antibodies. Although constipation, diarrhea, and abdominal pain were reduced in patients with antigliadin IgG and IgA, only pain decreased in patients without these antibodies. Gastrointestinal transit normalized in a higher proportion of patients with antigliadin IgG and IgA. Anxiety, depression, somatization, and well-being increased in both groups. The presence of antigliadin IgG was associated with overall reductions in symptoms (adjusted odds ratio compared with patients without this antibody, 128.9; 95% CI, 1.16–1427.8; P = .04). Symptoms were reduced even in patients with antigliadin IgG and IgA who reduced gluten intake but were not strictly compliant with the GFD. In controls, a GFD had no effect on gastrointestinal symptoms or gut function. Conclusions: Antigliadin IgG can be used as a biomarker to identify patients with IBS who might have reductions in symptoms, particularly diarrhea, on a GFD. Larger studies are needed to validate these findings. ClinicalTrials.gov: NCT03492333.

Original language	English (US)
Pages (from-to)	2343-2352.e8
Journal	Clinical Gastroenterology and Hepatology
Volume	19
Issue number	11
DOIs	https://doi.org/10.1016/j.cgh.2020.08.040
State	Published - Nov 2021

Keywords

FODMAP
IBS
antigliadin antibodies
biomarkers
diarrhea
gastrointestinal transit
gluten-free diet

ASJC Scopus subject areas

Hepatology
Gastroenterology

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10.1016/j.cgh.2020.08.040

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Pinto-Sanchez, M. I., Nardelli, A., Borojevic, R., De Palma, G., Calo, N. C., McCarville, J., Caminero, A., Basra, D., Mordhorst, A., Ignatova, E., Hansen, S., Uhde, M., Norman, G. L., Murray, J. A., Smecuol, E., Armstrong, D., Bai, J. C., Schuppan, D., Collins, S. M., ... Bercik, P. (2021). Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG. Clinical Gastroenterology and Hepatology, 19(11), 2343-2352.e8. https://doi.org/10.1016/j.cgh.2020.08.040

Pinto-Sanchez, MI, Nardelli, A, Borojevic, R, De Palma, G, Calo, NC, McCarville, J, Caminero, A, Basra, D, Mordhorst, A, Ignatova, E, Hansen, S, Uhde, M, Norman, GL, Murray, JA, Smecuol, E, Armstrong, D, Bai, JC, Schuppan, D, Collins, SM, Alaedini, A, Moayyedi, P, Verdu, EF & Bercik, P 2021, 'Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG', Clinical Gastroenterology and Hepatology, vol. 19, no. 11, pp. 2343-2352.e8. https://doi.org/10.1016/j.cgh.2020.08.040

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title = "Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG",

abstract = "Background & Aims: Many patients with irritable bowel syndrome (IBS) perceive that their symptoms are triggered by wheat-containing foods. We assessed symptoms and gastrointestinal transit before and after a gluten-free diet (GFD) in unselected patients with IBS and investigated biomarkers associated with symptoms. Methods: We performed a prospective study of 50 patients with IBS (ROME III, all subtypes), with and without serologic reactivity to gluten (antigliadin IgG and IgA), and 25 healthy subjects (controls) at a university hospital in Hamilton, Ontario, Canada, between 2012 and 2016. Gastrointestinal transit, gut symptoms, anxiety, depression, somatization, dietary habits, and microbiota composition were studied before and after 4 weeks of a GFD. HLA-DQ2/DQ8 status was determined. GFD compliance was assessed by a dietitian and by measuring gluten peptides in stool. Results: There was no difference in symptoms among patients at baseline, but after the GFD, patients with antigliadin IgG and IgA reported less diarrhea than patients without these antibodies (P = .03). Compared with baseline, IBS symptoms improved in 18 of 24 patients (75%) with antigliadin IgG and IgA and in 8 of 21 patients (38%) without the antibodies. Although constipation, diarrhea, and abdominal pain were reduced in patients with antigliadin IgG and IgA, only pain decreased in patients without these antibodies. Gastrointestinal transit normalized in a higher proportion of patients with antigliadin IgG and IgA. Anxiety, depression, somatization, and well-being increased in both groups. The presence of antigliadin IgG was associated with overall reductions in symptoms (adjusted odds ratio compared with patients without this antibody, 128.9; 95% CI, 1.16–1427.8; P = .04). Symptoms were reduced even in patients with antigliadin IgG and IgA who reduced gluten intake but were not strictly compliant with the GFD. In controls, a GFD had no effect on gastrointestinal symptoms or gut function. Conclusions: Antigliadin IgG can be used as a biomarker to identify patients with IBS who might have reductions in symptoms, particularly diarrhea, on a GFD. Larger studies are needed to validate these findings. ClinicalTrials.gov: NCT03492333.",

keywords = "FODMAP, IBS, antigliadin antibodies, biomarkers, diarrhea, gastrointestinal transit, gluten-free diet",

author = "Pinto-Sanchez, {Mar{\'i}a In{\'e}s} and Andrea Nardelli and Rajka Borojevic and {De Palma}, Giada and Calo, {Natalia Causada} and Justin McCarville and Alberto Caminero and Daniel Basra and Alexa Mordhorst and Ekatherina Ignatova and Suzanne Hansen and Melanie Uhde and Norman, {Gary L.} and Murray, {Joseph A.} and Edgardo Smecuol and David Armstrong and Bai, {Julio C.} and Detlef Schuppan and Collins, {Stephen M.} and Armin Alaedini and Paul Moayyedi and Verdu, {Elena F.} and Premysl Bercik",

note = "Funding Information: Funding This study was funded by a grant from the Boris Family Foundation , Canadian Institutes of Health Research (CIHR) grant 142773 (E.F.V.), and CIHR Foundation grant 143253 (P.B. and S.M.C.). Supported by a CIHR fellowship, Crohn{\textquoteright}s and Colitis Canada Innovation grant, and a McMaster University Department of Medicine Internal Career Award (M.I.P.S.). Also supported by a Canada Research Chair (E.F.V.) and the Richard Hunt-AstraZeneca Chair in Gastroenterology (P.B.). Funding Information: Funding This study was funded by a grant from the Boris Family Foundation, Canadian Institutes of Health Research (CIHR) grant 142773 (E.F.V.), and CIHR Foundation grant 143253 (P.B. and S.M.C.). Supported by a CIHR fellowship, Crohn's and Colitis Canada Innovation grant, and a McMaster University Department of Medicine Internal Career Award (M.I.P.S.). Also supported by a Canada Research Chair (E.F.V.) and the Richard Hunt-AstraZeneca Chair in Gastroenterology (P.B.). Publisher Copyright: {\textcopyright} 2021 AGA Institute",

year = "2021",

month = nov,

doi = "10.1016/j.cgh.2020.08.040",

language = "English (US)",

volume = "19",

pages = "2343--2352.e8",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders Ltd",

number = "11",

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TY - JOUR

T1 - Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG

AU - Pinto-Sanchez, María Inés

AU - Nardelli, Andrea

AU - Borojevic, Rajka

AU - De Palma, Giada

AU - Calo, Natalia Causada

AU - McCarville, Justin

AU - Caminero, Alberto

AU - Basra, Daniel

AU - Mordhorst, Alexa

AU - Ignatova, Ekatherina

AU - Hansen, Suzanne

AU - Uhde, Melanie

AU - Norman, Gary L.

AU - Murray, Joseph A.

AU - Smecuol, Edgardo

AU - Armstrong, David

AU - Bai, Julio C.

AU - Schuppan, Detlef

AU - Collins, Stephen M.

AU - Alaedini, Armin

AU - Moayyedi, Paul

AU - Verdu, Elena F.

AU - Bercik, Premysl

N1 - Funding Information: Funding This study was funded by a grant from the Boris Family Foundation , Canadian Institutes of Health Research (CIHR) grant 142773 (E.F.V.), and CIHR Foundation grant 143253 (P.B. and S.M.C.). Supported by a CIHR fellowship, Crohn’s and Colitis Canada Innovation grant, and a McMaster University Department of Medicine Internal Career Award (M.I.P.S.). Also supported by a Canada Research Chair (E.F.V.) and the Richard Hunt-AstraZeneca Chair in Gastroenterology (P.B.). Funding Information: Funding This study was funded by a grant from the Boris Family Foundation, Canadian Institutes of Health Research (CIHR) grant 142773 (E.F.V.), and CIHR Foundation grant 143253 (P.B. and S.M.C.). Supported by a CIHR fellowship, Crohn's and Colitis Canada Innovation grant, and a McMaster University Department of Medicine Internal Career Award (M.I.P.S.). Also supported by a Canada Research Chair (E.F.V.) and the Richard Hunt-AstraZeneca Chair in Gastroenterology (P.B.). Publisher Copyright: © 2021 AGA Institute

PY - 2021/11

Y1 - 2021/11

N2 - Background & Aims: Many patients with irritable bowel syndrome (IBS) perceive that their symptoms are triggered by wheat-containing foods. We assessed symptoms and gastrointestinal transit before and after a gluten-free diet (GFD) in unselected patients with IBS and investigated biomarkers associated with symptoms. Methods: We performed a prospective study of 50 patients with IBS (ROME III, all subtypes), with and without serologic reactivity to gluten (antigliadin IgG and IgA), and 25 healthy subjects (controls) at a university hospital in Hamilton, Ontario, Canada, between 2012 and 2016. Gastrointestinal transit, gut symptoms, anxiety, depression, somatization, dietary habits, and microbiota composition were studied before and after 4 weeks of a GFD. HLA-DQ2/DQ8 status was determined. GFD compliance was assessed by a dietitian and by measuring gluten peptides in stool. Results: There was no difference in symptoms among patients at baseline, but after the GFD, patients with antigliadin IgG and IgA reported less diarrhea than patients without these antibodies (P = .03). Compared with baseline, IBS symptoms improved in 18 of 24 patients (75%) with antigliadin IgG and IgA and in 8 of 21 patients (38%) without the antibodies. Although constipation, diarrhea, and abdominal pain were reduced in patients with antigliadin IgG and IgA, only pain decreased in patients without these antibodies. Gastrointestinal transit normalized in a higher proportion of patients with antigliadin IgG and IgA. Anxiety, depression, somatization, and well-being increased in both groups. The presence of antigliadin IgG was associated with overall reductions in symptoms (adjusted odds ratio compared with patients without this antibody, 128.9; 95% CI, 1.16–1427.8; P = .04). Symptoms were reduced even in patients with antigliadin IgG and IgA who reduced gluten intake but were not strictly compliant with the GFD. In controls, a GFD had no effect on gastrointestinal symptoms or gut function. Conclusions: Antigliadin IgG can be used as a biomarker to identify patients with IBS who might have reductions in symptoms, particularly diarrhea, on a GFD. Larger studies are needed to validate these findings. ClinicalTrials.gov: NCT03492333.

AB - Background & Aims: Many patients with irritable bowel syndrome (IBS) perceive that their symptoms are triggered by wheat-containing foods. We assessed symptoms and gastrointestinal transit before and after a gluten-free diet (GFD) in unselected patients with IBS and investigated biomarkers associated with symptoms. Methods: We performed a prospective study of 50 patients with IBS (ROME III, all subtypes), with and without serologic reactivity to gluten (antigliadin IgG and IgA), and 25 healthy subjects (controls) at a university hospital in Hamilton, Ontario, Canada, between 2012 and 2016. Gastrointestinal transit, gut symptoms, anxiety, depression, somatization, dietary habits, and microbiota composition were studied before and after 4 weeks of a GFD. HLA-DQ2/DQ8 status was determined. GFD compliance was assessed by a dietitian and by measuring gluten peptides in stool. Results: There was no difference in symptoms among patients at baseline, but after the GFD, patients with antigliadin IgG and IgA reported less diarrhea than patients without these antibodies (P = .03). Compared with baseline, IBS symptoms improved in 18 of 24 patients (75%) with antigliadin IgG and IgA and in 8 of 21 patients (38%) without the antibodies. Although constipation, diarrhea, and abdominal pain were reduced in patients with antigliadin IgG and IgA, only pain decreased in patients without these antibodies. Gastrointestinal transit normalized in a higher proportion of patients with antigliadin IgG and IgA. Anxiety, depression, somatization, and well-being increased in both groups. The presence of antigliadin IgG was associated with overall reductions in symptoms (adjusted odds ratio compared with patients without this antibody, 128.9; 95% CI, 1.16–1427.8; P = .04). Symptoms were reduced even in patients with antigliadin IgG and IgA who reduced gluten intake but were not strictly compliant with the GFD. In controls, a GFD had no effect on gastrointestinal symptoms or gut function. Conclusions: Antigliadin IgG can be used as a biomarker to identify patients with IBS who might have reductions in symptoms, particularly diarrhea, on a GFD. Larger studies are needed to validate these findings. ClinicalTrials.gov: NCT03492333.

KW - FODMAP

KW - IBS

KW - antigliadin antibodies

KW - biomarkers

KW - diarrhea

KW - gastrointestinal transit

KW - gluten-free diet

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Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG

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